Tinnitus ALI KALAN Consultant ENT Surgeon Hillingdon, Mount Vernon, Central Middlesex & Northwick Park Hospitals North West London Hospitals NHS Trusts

Tinnitus Tinnitus is defined as the “perception of a sound” that is generated involuntarily within the head of an individual

Tinnitus Prevalence in the adult population of around 10%. severe in 1 % -- affecting daily life routine 78 % of adult population will experience tinnitus at least once during their lifetime

Tinnitus -- Types Subjective Objective

Tinnitus - causes The majority of patients with tinnitus do not have any identifiable underlying pathology except for age-related sensorineural hearing loss

Conductive hearing loss Clinical examination and audiology Condition Diagnosis Conductive hearing loss Clinical examination and audiology Ossicular erosion Ossicular fixation Otosclerosis Middle ear effusion/patulous ET Neoplastic Vestibular schwannoma MRI with DTPA-Gadolinium Glomus jugulare Clinical examination and imaging Ototoxic drugs Salicylates History Aminoglycasides Loop diuretics Meniere’s disease History, audiology, electrocochleography Vascular Carotid artery stenosis Clinical examination and duplex ultrasound scan Venous sinus stenosis Angiography IAM vascular loop MRI+ ⁄ - angiography Myoclonus Stapedius History, clinical examination, tympanometry Tensor tympani Palatal Other : Benign intracranial hypertension History, clinical examination, MRI, lumbar puncture

History --- what to cover ? Character :unilateral/bilateral persistent/intermittent type : clicking,pulsatile,whirring etc Intensity/severity – “Klockhoff & Lindblom Grading “ Hyperacusis – 40% (recruitment) Impact on quality of life : sleep(35%),depression,suicidal Associated otological symptoms Medications :salicylates,loop diuretics etc

Examination Otoscopy Auscultation : neck Fundi : pappiloedema (BIH) oropharyngeal

Investigations Pure tone audiogram Impedance audiometry MRI brain Duplex ultrasound – carotid bruit Lumber puncture

Management Treat the organic pathology, when known, on its own merits Counselling : mainstay Hearing aid : when hearing loss accompanied Tinnitus maskers (adaptation) Medication : no role Surgery : rarely considered Cognitive behavioural therapy : for selected refractory tinnitus Habituation therapy (tinnitus retraining): for refractory cases Complementary therapies : no evidence Self help groups : British Tinnitus association etc.